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Judy is a pretty woman of about 30, whose striking features and cascade of straight auburn hair could easily be those of a model whose picture stares out at you from the window of a hair salon as testimony to the hairstylist’s skills. What hardly anyone knows is that for about 20 years of her life Judy had been regularly pulling out thousands of her hairs, leaving behind bald patches as wide as golf balls. It was terribly embarrassing for her to look at these bald patches and she would go to great lengths to conceal them with swatches of hair held down with hair grips or hairspray. In school she would stand at the back of the queue so that no one would get too close to her. At the seaside, she would avoid putting her head under water for fear the waves would sweep her hair to the side and expose the source of her embarrassment. Even when she met the man she was ultimately to marry, she resisted showering with him or letting him see the bald spots and, when it was finally impossible to conceal them from him, she told him that they were the result of a bicycling accident.

Judy began to pull her hair out when she was 13 years old, shortly after the death of her beloved grandmother, the person to whom she felt closer than anyone in the world. She felt sad and lonely and unable to talk about it to her family, who were all busy getting on with their own lives. One day during a maths lesson, she found herself pulling at her hair and felt comforted. That was the beginning of her secret addiction.

To add to her problem with hair-pulling, Judy began to suffer from panic attacks when she was 23. These occurred specifically when she went out to eat at restaurants. In the middle of a meal, her heart would start to pound, her hands became sweaty and she was unable to swallow her food. Since dining out was one of her husband’s favourite activities, this problem made her very unhappy. She took the anti-anxiety drug Xanax when she went out to dinner, which helped a little, but the panic persisted and she was still unable to enjoy the meal. After a while she began to anticipate with dread the prospect of dinner plans at a fancy restaurant and the persistent fear of having a panic attack felt worse than the panic itself.

Now in her thirties, Judy finally took her problem to a therapist and was given Prozac, a common type of treatment for panic attacks, but it made her feel unpleasantly jittery and she stopped taking it. Her husband’s 40th birthday was approaching and they had planned a trip to Bermuda to celebrate. She knew that one of the highlights of the trip for him would be dining out at some of the fine restaurants on the island. She very much wanted to be able to enjoy that with him. At about this time she heard about St John’s Wort and decided to give it a try, even though there was no evidence that it was of benefit to people with panic attacks.

Judy started on St John’s Wort at a dosage of 300 mg per day, and felt a sense of calm within one day. Since she observed no side-effects, she increased the dosage to 300 mg twice a day for the following five weeks. She and her husband went to Bermuda and, to her amazement, she was able to enjoy going to restaurants for the first time in many years. The panic attacks disappeared and she felt no need for Xanax any longer. Even more amazingly, she no longer had any desire to pull her hair out and she was even willing to show me the patches where fine hairs have begun to grow back again. For the first time in 20 years she has no bald patches that she has to cover or feel embarrassed about. She could barely contain her excitement at the fact that she feels no need to pull her hair out any more, and her eagerness to share her story with fellow-sufferers.


Judy’s problem of compulsive hair-pulling has a name – trichotillomania. It is surprisingly common among women who, like Judy, frequently conceal it from others by covering the bald spots over with hair. The condition is known to be very hard to treat and anti-depressants, such as the SSRIs, which are so helpful in treating depression, panic disorder, bulimia and obsessive-compulsive disorder, are much less successful in the treatment of trichotillomania. Behavioural strategies to reduce the ease of hair-pulling, such as covering the head with a baseball cap or scarf, putting slippery styling mousse on to make it harder to pull out the hairs, or wearing gloves, may be of some help. But it is an uphill battle for those who are addicted to this activity. If St John’s Wort proves to be helpful even in a small percentage of individuals affected by this painful and embarrassing condition, a great deal of suffering will be alleviated.


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